The influence of the municipal human development index and maternal education on infant mortality: an investigation in a retrospective cohort study in the extreme south of Brazil

Abstract

Background Infant mortality is considered an important and sensitive health indicator in several countries, especially in underdeveloped and developing countries. Most of the factors influencing infant mortality are interrelated and are the result of social issues. Therefore, this study performed an investigation of the influence of the MHDI and maternal education on infant mortality in a capital in the extreme south of Brazil. Methods It is a retrospective cohort study with data on births and deaths in the first year of life for the period of 2000–2017. The association between the independent variables and the outcome was done by bivariate analysis through simple Poisson regression. The variables that can potentially be considered confounding factors were used in a multiple Poisson regression for robust variances - adjusted model. Results The study included 317,545 children, of whom 3107 died. The medium MHDI showed associated with infant death in the first year of life. Maternal education, individually and jointly analyzed with the MHDI, showed association with the outcome of infant death in the first year of life, particularly for children of mothers with lower maternal education (p < 0.001). In relation to other related factors, maternal age; number of Prenatal Care Consultations; gestational age, weight, gender and Apgar Index (5th minute) of the newborn showed association with IM (p < 0.001). Conclusions The HDI is considered a good predictor of infant mortality by some authors and the analyzes of the present study also confirm an association of the medium MHDI and its low MHDIE component with infant mortality. In addition, it was maternal education with less than 8 years of study that that demonstrated a higher risk of death, revealing itself to be a social determinant with a relevant impact on infant mortality. Thus, it is possible to conclude that maternal education is available information, and it is superior to the MHDI to assess the infant mortality outcome.

Prevalence of Congenital Anomaly and Its Relationship with Maternal Education and Age According to Local Development in the Extreme South of Brazil

“…Low maternal education is consistently cited as a risk factor for complications in pregnancy and lower adherence to recommendations and is usually related to worse socioeconomic conditions [13,14,27,42]. In this study, we observed an association of CA with lower education only in very high development regions (RR 1.27 95% CI 1.03-1.54), suggesting that the mother's individual choices, such as better adherence to recommendations, may outweigh the exposure of the socioeconomic environment in which she lives.…”

Mortalidade infantil associada às iniquidades sociais: revisão de escopo

“…The influence of the municipal human development index and maternal education on infant mortality: an investigation in a retrospective cohort study in the extreme south of Brazil (59) 2021/Brasil Estudo de coorte/ n=3.107…”

“…• A baixa escolaridade materna está associada a maior taxa de mortalidade infantil (2)(3)(4)(5)(6)(7)(8)11,(21)(22)(23)(25)(26)(27)32,33,35,(41)(42)(43)(44)(45)49,52,54,(58)(59)(60)(62)(63)(64)(65) , a alta taxa de mortalidade infantil (3,19,36,49,(55)(56)(57) , a mortalidade evitável no primeiro dia (30) e a mortalidade infantil prematura em unidade terapia intensiva neonatal (16) .…”

“…• Gravidez/maternidade na adolescência está relacionada a mortalidade infantil (15,34) a taxa de mortalidade infantil é maior em mulheres com menor idade (8,25,33,52,56,59) , a taxa de mortalidade infantil é maior em mães com idade < 20 anos (19) e menor em idade entre 25 a 49 anos (4) .…”

Mortality inequalities measured by socioeconomic indicators in Brazil: a scoping review

“…In Brazil, several studies provide evidence of higher mortality rates in more impoverished areas 9 . Many are the composite socioeconomic measures available at the municipal level, such as the Social Vulnerability Index ( Índice de Vulnerabilidade Social – IVS) 12 , and the Municipal Human Development Index (MHDI) 13 – still, mortality rates can be highly heterogeneous 14 , making more disaggregated analyses desirable.…”